IVF/ICSI in Istanbul: Evidence-Based Fertility Treatment with Surgical Optimisation
Many couples struggling to conceive have already been through several attempts, conflicting advice or unsuccessful treatments before they even consider fertility treatment abroad. Yet success is often decided not by the method alone, but by whether the real cause of infertility has been identified and treated. At the practice of Associate Professor Dr. Cengiz Andan in Istanbul (Şişli) we follow exactly this path: first find the cause, treat it where possible, and then plan the IVF together with a specialised fertility centre. For couples coming from the UK and beyond, this means honest, step-by-step support – without unrealistic promises.
At a glance
- What it is: In fertility treatment, egg and sperm are brought together outside the body (IVF) or a single sperm is injected directly into the egg (ICSI).
- Methods: IUI (insemination), IVF and ICSI – depending on the cause.
- Success: strongly age-dependent; over 40% per transfer into the early 30s, falling with age – with no guarantee.
- Legal framework in Turkey: only for married couples using their own eggs and sperm; no egg or sperm donation, no surrogacy.
- From abroad: preparation and diagnosis start online; the length of stay depends on cycle timing.
What is fertility treatment – and which methods are there (IVF, ICSI, IUI)?
Fertility treatment is the umbrella term for several assisted reproduction procedures that differ markedly in how involved they are. With insemination (IUI), prepared sperm is placed directly into the uterus, while with in vitro fertilisation (IVF) egg and sperm are brought together outside the body in the laboratory. ICSI is a further development in which a single sperm is injected directly into the egg – useful above all when sperm quality is reduced. Fertilised eggs can also be frozen and transferred in a later cycle (frozen transfer).
| Method | Suitable for | Key feature |
|---|---|---|
| IUI (insemination) | mild limitation, open tubes | simplest procedure |
| IVF | blocked tubes, normal sperm | fertilisation in the lab |
| ICSI | reduced sperm quality | sperm is injected |
| Frozen transfer | existing frozen embryos | no renewed stimulation |
How does an IVF treatment work, step by step?
An IVF treatment follows a fixed sequence over roughly two to three weeks. First, the ovaries are stimulated with hormones over around 8–12 days so that several eggs mature. The eggs are then retrieved in a short procedure of about 5–10 minutes under anaesthesia and brought together with the sperm in the laboratory. After a few days of embryo culture, one embryo is transferred into the uterus, and about two weeks later a test shows whether a pregnancy has occurred.
Which investigations clarify the cause of infertility?
Before any treatment comes the question of why conception has not happened so far. In the woman, the AMH level and hormone profile give information about the egg reserve, while ultrasound and, where appropriate, a hysteroscopy assess the uterine cavity and the tubes. In the man, the semen analysis is the most important test. Only once the cause is clear can it be decided whether a simple insemination, an IVF or an operation first is the most sensible path.
Source: European Society of Human Reproduction and Embryology (ESHRE), guidelines on fertility treatment
How high are the success rates – and how honestly do they depend on age?
The success rates of fertility treatment depend on the woman's age more than on any other factor. Up to about the age of 32, the pregnancy rate per embryo transfer is over 40%, after which it falls with each year.
At 40, the chance per attempt is still around 22%, at 44 only about 7%. Over several attempts, however, the chances add up: after three transfers the cumulative pregnancy rate is around 78%.
Serious counselling means stating these figures openly and giving no guarantees – because a pregnancy cannot be medically promised.
| Woman's age | Pregnancy rate per transfer | Birth rate |
|---|---|---|
| up to 32 years | over 40% | over 30% |
| 35–37 years | about 35% | somewhat lower |
| 41 years | about 26% | about 15% |
| from 43 years | clearly lower | low |
Source: Human Fertilisation and Embryology Authority (HFEA), fertility treatment statistics
Why do we treat the cause before IVF – and when does an operation make sense?
Fertility treatment works best when the underlying cause has been treated beforehand. Endometriosis, fibroids or polyps in the uterine cavity can disturb the implantation of the embryo, which is why a prior operation can improve the chances here. This is especially clear with a hydrosalpinx, a fluid-filled, blocked fallopian tube: this fluid is toxic to the embryo and can lower the IVF success rate by up to around 50%. Removing the affected tube improves implantation and pregnancy rates without reducing the ovarian reserve – and these are exactly the procedures we plan deliberately before IVF.
Source: American Society for Reproductive Medicine (ASRM), recommendations on hydrosalpinx and ART
Which "add-ons" are offered – and what do they really achieve?
Numerous extras are offered around fertility treatment whose benefit is often not scientifically proven. For so-called endometrial scratching, for example, an analysis of several randomised studies showed no demonstrable advantage in the birth rate, which is why this measure is advised against in the first IVF cycle. The ERA test, embryo glue, immunotherapies and stem-cell treatments of the ovaries also still lack convincing evidence; they are considered experimental. It therefore makes sense to rely on proven measures and to question unproven extras critically, since above all they increase the cost.
Source: National Institute for Health and Care Excellence (NICE), assessment of IVF add-ons
ICSI or conventional IVF – which method suits us?
Whether conventional IVF or ICSI is chosen depends above all on sperm quality. With normal sperm values, conventional IVF often suffices, in which the sperm fertilise the egg themselves in the culture dish. If sperm quality is clearly reduced, ICSI is used to place a single sperm directly into the egg. The honest assessment matters: without a male factor, ICSI brings no automatic advantage, with the fertilisation rates of both methods lying close together at about 53% to 58%.
What risks and side effects does fertility treatment have?
Fertility treatment is safe overall, but couples should be aware of a few risks. The most important is ovarian hyperstimulation (OHSS), which in its severe form occurs in only about 0.2% of treatments and can usually be avoided through adjusted stimulation. If several embryos are transferred, the likelihood of a multiple pregnancy also rises – around 21% of children born after fertility treatment are twins. Before every treatment we discuss these risks openly and adapt the stimulation to the individual situation.
Note: Severe abdominal pain, rapid weight gain or shortness of breath after stimulation can be signs of overstimulation and should be assessed by a doctor promptly.
What does the treatment approach of Associate Professor Dr. Cengiz Andan look like?
Our approach begins not with IVF but with the cause. We first carefully clarify why conception has not happened so far, and treat treatable causes such as endometriosis, fibroids, polyps or a hydrosalpinx before moving on to fertility treatment. The IVF or ICSI itself we plan and coordinate together with a specialised fertility centre and its embryology laboratory. In doing so we advise honestly and on the evidence, give no guarantees and remain a reliable point of contact for our patients throughout the whole path.
What role does the doctor have – and what role the IVF laboratory?
Successful fertility treatment is teamwork between doctor and laboratory. The doctor takes on the diagnosis, the surgical treatment of the causes and the planning of the treatment path, while the specialised fertility centre with its embryology laboratory carries out the fertilisation, the embryo culture and the transfer. Associate Professor Dr. Cengiz Andan has 18 years of experience, is certified by the Turkish Ministry of Health for fertility treatment and has carried out more than 500 endometriosis operations – a focus that counts precisely in treating the cause before an IVF. This clear division of roles ensures that each step is taken on by the place best suited to it.
What is legally permitted in Turkey – and what is not?
The legal framework for fertility treatment is clearly regulated in Turkey and should be known before travelling. Treatment is permitted exclusively for married couples and only with their own eggs and sperm. Egg, sperm or embryo donation as well as surrogacy are completely prohibited. Genetic testing of the embryos (PGD/PGT) is allowed only for medical reasons, while selecting the sex for non-medical reasons is not.
| Permitted | Not permitted |
|---|---|
| married couples | unmarried/single individuals |
| own eggs and sperm | egg, sperm, embryo donation |
| PGD/PGT for a medical reason | sex selection without a medical reason |
| freezing in permitted cases | surrogacy |
What to do when conception fails after several unsuccessful attempts?
After several unsuccessful attempts it is worth stepping back and reviewing the cause again. Often a treatable cause such as endometriosis, a hydrosalpinx or a uterine finding has been overlooked, and correcting it can improve the starting position. Sometimes a change of method or an adjustment of the stimulation also makes sense. In this situation an independent second opinion is especially valuable, so as not to repeat the same path unchecked.
Home country or Istanbul? Where does the difference lie?
The medical quality is very high in both cases – the difference lies not in the method, but in waiting time, cycle limits and cost. In Istanbul the same procedures and laboratory standards are used as at home. Waiting times are often shorter, and while in the UK the NHS often funds only a limited number of cycles, planning abroad is more flexible. That the costs are lower has to do with the exchange rate and lower operating costs – not with compromises on the standard. As a guide, an IVF cycle in Istanbul costs roughly USD 3,000 to 4,500.
| Feature | Home country | Istanbul |
|---|---|---|
| Quality / lab standard | very high | very high |
| Waiting time | often longer | usually shorter |
| Cycle limit | often limited | more flexible to plan |
| Cost | higher | lower |
What happens after the treatment, once I am back home?
Many couples from abroad wonder how things continue after the transfer and the return journey. After the treatment we remain reachable, answer questions on continuing medication and coordinate where needed with the treating doctor at home. You receive all results and reports that your local gynaecologist can use directly for ongoing care – for example once a pregnancy has occurred. In this way the transition into care at home is organised seamlessly.
How do I organise travel, stay and cycle timing from abroad?
The process for international couples is planned so that as much as possible is prepared before arrival. Diagnosis and treatment planning begin online; existing results, the semen analysis and imaging from home are a great help here. Because fertility treatment is tied to the cycle, the stay is timed precisely around egg retrieval and transfer and lasts, depending on the approach, from several days to about two weeks. A flight is usually possible without problems after the transfer, but should be coordinated with the treating team.
How do I get a medical second opinion – online as well?
A well-founded second opinion can bring a lot of clarity, especially after unsuccessful attempts. When you send us your results, the semen analysis and any existing imaging, we look at them and assess whether a treatable cause is present or another path makes sense. This online consultation is a paid medical service and does not replace an in-person examination, but it helps with an informed decision. You can make contact easily via the form or WhatsApp.
Frequently asked questions
That depends on age, cause and previous results. Because the chances add up over several attempts, a further cycle often makes sense after an unsuccessful first one; in women under 35 the cumulative birth rate after several cycles reaches up to around 85%, falling clearly with age. After several unsuccessful attempts, however, the cause should be reviewed again.
Retrieval is carried out under brief anaesthesia and takes only about 5–10 minutes. Afterwards a mild pulling in the lower abdomen and some tiredness may occur. Most women are back to their normal routine the next day.
From hormonal stimulation to the pregnancy test, about two to three weeks pass. Stimulation lasts around 8–12 days, followed by retrieval, fertilisation and transfer. With a frozen transfer the renewed stimulation is not needed.
After the transfer, normal light activity is allowed; strict bed rest is not necessary and does not improve the chances. A flight is usually possible without problems. Heavy physical strain should be avoided in the first few days.
In a fresh transfer the embryo is transferred in the same cycle, in a frozen transfer a previously frozen embryo is transferred in a later cycle. The frozen transfer allows better preparation of the uterine lining and lowers the risk of overstimulation. Which path suits depends on the individual case.
The AMH level reflects the egg reserve and falls naturally with age. A low value usually means fewer retrievable eggs, but on its own says little about egg quality. The consultation therefore always also considers age and the overall picture.
No. Genetic testing is permitted in Turkey only for medical reasons, for example to detect serious hereditary diseases. Selecting the sex for non-medical reasons is prohibited by law.
As a rule a single embryo is transferred to avoid multiple pregnancies. The more embryos transferred, the higher the risk of twins or triplets with the corresponding pregnancy risks; triplets remain rare at around 0.7%. The decision depends on age and embryo quality.
With certain findings, yes. Above all a hydrosalpinx, but also polyps or fibroids that distort the uterus, can disturb implantation, so a prior operation improves the starting position. Whether surgery makes sense depends on the specific finding.
A healthy weight, giving up smoking, moderate exercise and taking folic acid early support the treatment. Managing stress also plays a part in wellbeing. These measures do not replace medical treatment but create better conditions.
A current semen analysis, the AMH level and hormone results, ultrasound or MRI images and reports of earlier treatments are helpful. The more complete the documents, the more precise the first assessment. Missing investigations can often be caught up on at home.
After your documents arrive, a first assessment follows promptly. For a detailed medical assessment a paid online appointment is arranged. You can make the first contact via the form or WhatsApp.
